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A Spine Robotic-Assisted Navigation System for Pedicle Screw Placement
Published on: May 11, 2020
Computer Navigation-aided Resection of Sacral Chordomas
Yong-Kun Yang, Chung-Ming Chan, Qing Zhang
1Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing 100035, China.
Background:
Resection of sacral chordomas is challenging. The anatomy is complex, and there are often no bony landmarks to guide the resection. Achieving adequate surgical margins is, therefore, difficult, and the recurrence rate is high. Use of computer navigation may allow optimal preoperative planning and improve precision in tumor resection. The purpose of this study was to evaluate the safety and feasibility of computer navigation-aided resection of sacral chordomas.
Methods:
Between 2007 and 2013, a total of 26 patients with sacral chordoma underwent computer navigation-aided surgery were included and followed for a minimum of 18 months. There were 21 primary cases and 5 recurrent cases, with a mean age of 55.8 years old (range: 35-84 years old). Tumors were located above the level of the S3 neural foramen in 23 patients and below the level of the S3 neural foramen in 3 patients. Three-dimensional images were reconstructed with a computed tomography-based navigation system combined with the magnetic resonance images using the navigation software. Tumors were resected via a posterior approach assisted by the computer navigation. Mean follow-up was 38.6 months (range: 18-84 months).
Results:
Mean operative time was 307 min. Mean intraoperative blood loss was 3065 ml. For computer navigation, the mean registration deviation during surgery was 1.7 mm. There were 18 wide resections, 4 marginal resections, and 4 intralesional resections. All patients were alive at the final follow-up, with 2 (7.7%) exhibiting tumor recurrence. The other 24 patients were tumor-free. The mean Musculoskeletal Tumor Society Score was 27.3 (range: 19-30).
Conclusions:
Computer-assisted navigation can be safely applied to the resection of the sacral chordomas, allowing execution of preoperative plans, and achieving good oncological outcomes. Nevertheless, this needs to be accomplished by surgeons with adequate experience and skill.
Insights
Computer navigation aids sacral chordoma resection, improving precision and oncological outcomes. This advanced technique is safe and feasible for experienced surgeons.
Area of Science:
- Neurosurgery
- Orthopedic Oncology
- Surgical Navigation
Background:
- Resection of sacral chordomas presents significant challenges due to complex anatomy and difficulty achieving adequate margins.
- High recurrence rates are associated with sacral chordoma surgery.
- Computer navigation offers potential for enhanced preoperative planning and surgical precision.
Purpose of the Study:
- To evaluate the safety and feasibility of computer navigation-assisted resection of sacral chordomas.
- To assess the impact of computer navigation on surgical outcomes for sacral chordoma patients.
Main Methods:
- A cohort of 26 patients with sacral chordoma (21 primary, 5 recurrent) underwent computer navigation-aided surgery between 2007 and 2013.
- Three-dimensional imaging combined CT and MRI data for preoperative planning and intraoperative guidance.
- Tumors were resected via a posterior approach utilizing computer navigation assistance.
Main Results:
- Mean operative time was 307 minutes with mean blood loss of 3065 ml.
- The mean registration deviation for computer navigation was 1.7 mm, indicating high precision.
- All patients survived, with a 7.7% tumor recurrence rate and a mean Musculoskeletal Tumor Society Score of 27.3.
Conclusions:
- Computer-assisted navigation is a safe and feasible technique for sacral chordoma resection.
- This technology facilitates the execution of preoperative plans and leads to favorable oncological outcomes.
- Successful application requires surgeons with substantial experience and skill in computer navigation.
